Except when they're taking on evil empires like the tobacco industry, surgeons general rarely muster much of an army with their finger-wagging health edicts. But when the incumbent commander, Regina M. Benjamin, issued "The Surgeon General's Call to Action to Support Breastfeeding" in January, a million mewling mouths opened as one, summoning their next meal.

At the Mothers' Milk Bank of California -- located in the same small gray trailer behind San Jose's Valley Medical Center where it began 37 years ago -- meeting the rising demand since the surgeon general gave breast milk her blessing has become almost impossible. Last week, Milk Bank executive director Pauline Sakamoto had to turn away hospitals where babies cried out for the nutrient-rich nectar.

"It's never been this bad," said Sakamoto, who's been in charge of the West Coast's only breast milk bank for 12 years. She expects to give away half a million ounces of mothers' milk this year -- if she can find it. Demand rises 15 to 18 percent a year in an average year, and since the surgeon general rallied a medical establishment that had been divided on the value of breastfeeding, demand has "skyrocketed," she said.

Breast milk has been shown to protect infants -- particularly those delivered prematurely -- against infection, it shortens their stay in the hospital, promotes growth and staves off allergies. Many mothers become so stressed after delivering pre-term babies that they're unable to produce milk of their own. And there are children born to drug-dependent mothers.

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"These kids are going through withdrawal," Sakamoto said. "Why would you want to put formula in their gut when they're going to be in pain with the formula? You want donor milk in there."

The shortage of mothers' milk has been exacerbated by a surprising source: the Internet. Sakamoto said many mothers have joined "casual sharing" networks -- breast milk exchanges -- while others have turned to selling their milk on eBay. Still another possible drain on the milk supply is Prolacta, a product sold for profit, but collected by other nonprofit milk banks.

"They're working to get the same product from volunteers, so it's harder for me to find the donors," Sakamoto said. "I have no milk to feed the babies that have prescriptions for milk. That's the shamefulness of it."

As the supply has dwindled, Milk Bank of California has narrowed its recipient list to neonatal intensive care units. "America needs to get its priorities straight," Sakamoto said. "We take responsibility for those that are the most fragile because people are doling milk off to the healthy."

Hearing about a "milk bank" for the first time, some people mistakenly envision a facility like a blood bank, where several women at a time are tethered to a giant breast pump -- an Orwellian vision of Big Mother.

But most of the donating is done at home, where mothers like Sarah Quigley, of San Francisco, pump the milk, then have it express delivered to the little trailer in San Jose -- all at the Milk Bank's expense. Quigley became interested in donating her milk following the birth of her first child, and when she had her second baby nine months ago, she went through the screening process and began producing.

"I have a generous milk supply and my own baby is thriving, so I thought it would be wonderful to help families who need the milk," she said. "I sit down every morning and pump my milk, and for the rest of the day I know that I've done something good for somebody else. It's been really rewarding for me."

The opportunity to donate milk has proved especially rewarding for mothers whose babies have died. "For some of the bereaved donors, this is a godsend," said Sakamoto. "They can continue to express milk, and know that there's a baby on the other end who's going to get it. Therapeutically, for them it's phenomenal."

Donor coordinator Jessica Welborn originally came to the Milk Bank while conducting research for a Ph.D. dissertation on why mothers donate milk after losing a baby. "For some bereaved mothers, having something positive come from something so tragic and painful is healing," Welborn said. Even when a baby died, mothers typically start producing milk, and need to pump for a few weeks to prevent physical discomfort.

For other mothers, however, donating allows them to transform too much of a good thing into a struggling child's good fortune.

"Sometimes when it comes up in conversation that I donate milk, a lot of moms say they don't think they could be organized enough to do that," Quigly said. "But really, to be a donor takes about 15 minutes of my time every day. And I feel it's time very well spent."

Contact Bruce Newman at 408-920-5004.

how to donate

Potential donors can call 408-998-4550, or toll-free at 877-375-6645. Instructions on how to become a donor can be found at www.sanjosemilkbank.com.